This phase II trial studies the effect of belinostat and SGI-110 (guadecitabine) or ASTX727 in treating patients with conventional chondrosarcoma that cannot be removed by surgery (unresectable) and has spread from where it first started (primary site) to other places in the body (metastatic). Belinostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Chemotherapy drugs, such as guadecitabine and ASTX727, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving belinostat in combination with guadecitabine or ASTX727 may lower the chance of unresectable and metastatic chondrosarcoma growing or spreading.
PRIMARY OBJECTIVE: I. To conduct a phase 2 clinical trial to evaluate whether combination treatment with belinostat and decitabine and cedazuridine (ASTX727) shows preliminary evidence of clinical activity in unresectable or metastatic conventional chondrosarcoma (CS) using an objective response rate endpoint. SECONDARY OBJECTIVES: I. To evaluate the toxicity profile associated with the belinostat and ASTX727. II. To evaluate the progression free survival (PFS) associated with the belinostat and ASTX727. III. To evaluate the toxicity profile, objective response rate and progression free survival among the initial six patients treated with belinostat and SGI-110 (guadecitabine) prior to Amendment 5 in which ASTX727 was substituted for SGI-110 (guadecitabine). CORRELATIVE OBJECTIVES: I. To determine the IDH1/2 mutational status of subject's tumors and to evaluate for a relationship between presence of IDH1/2 mutation and clinical benefit from study treatment. II. To conduct ribonucleic acid sequencing (RNAseq) analysis using baseline and on-treatment tissue biopsies to study the effects of study treatment on CS gene expression patterns and identify candidate genes which may underlie treatment efficacy. III. To evaluate for changes in global deoxyribonucleic acid (DNA) methylation levels using baseline and on-treatment biopsies and correlate changes in global methylation with clinical benefit from study treatment. IV. To use multiplex immunohistochemistry to interrogate the immune microenvironment in baseline and on-treatment tissue biopsies to define changes in infiltrating immune cell subsets and PD-L1/major histocompatibility complex (MHC) expression by immune and tumor cells associated with study treatment. OUTLINE: Patients receive guadecitabine subcutaneously (SC) or ASTX727 orally (PO) on days 1-5. Patients also receive belinostat intravenously (IV) over 30 minutes on days 1-5. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. Patients also undergo collection of blood during screening, tumor biopsy during screening and on study, and magnetic resonance imaging (MRI) or computed tomography (CT) throughout the trial. After completion of study treatment, patients are followed up every 3 months for 24 months.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
19
Given IV
Undergo biopsy
Undergo collection of blood
Undergo CT
Given PO
Given SC
Undergo MRI
Mayo Clinic Hospital in Arizona
Phoenix, Arizona, United States
City of Hope Comprehensive Cancer Center
Duarte, California, United States
Los Angeles General Medical Center
Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center
Los Angeles, California, United States
USC Norris Oncology/Hematology-Newport Beach
Newport Beach, California, United States
Objective Response Rate (ORR) in Belinostat, ASTX727
Best Objective Response per RECIST Version 1.1 criteria. CR, complete response defined by the disappearance of all target lesions; PR, partial response defined by at least a 30% decrease in the sum of the diameters of target lesions; SD, stable disease defined by neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease; PD, progressive disease defined by at least a 20% increase in the sum of the diameters of target lesions or the appearance of one or more new lesions.
Time frame: Within 6 months after initiating study treatment
Presence of Treatment Related Adverse Events (AEs) in Belinostat, ASTX727
Adverse events (AEs) in belinostat, ASTX727 were recorded at each clinical visit and were categorized according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. The attribution of AEs to each of the study drugs was recorded and categorized as possibly, probably, or definitely related to treatment. AEs are reported as counts and percentages per AE by grade and the number of patients with a given maximal grade of toxicity.
Time frame: Up to 24 months post treatment
Progression Free Survival (PFS) in Belinostat, ASTX727
PFS is defined as the time from first treatment with the study drug to the earliest of either disease progression or death from any cause. Patients who are alive and progression free will be censored at the time of their last follow-up. The Kaplan-Meier method was used to evaluate time to event endpoints. Median PFS was reported with a 95% confidence interval. Data will be presented as Kaplan Meier plots.
Time frame: Time from first treatment with the study drug to the earliest of either disease progression or death from any cause, assessed up to 24 months.
Presence of Treatment Related Adverse Events (AEs) in Belinostat, SGI-110
Adverse events (AEs) from belinostat, SGI-110 were recorded at each clinical visit and were categorized according to National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. The attribution of AEs to each of the study drugs was recorded and categorized as possibly, probably, or definitely related to treatment. AEs are reported as counts and percentages per AE by grade and the number of patients with a given maximal grade of toxicity.
Time frame: Up to 24 months post treatment
Progression Free Survival (PFS) in Belinostat, SGI-110
PFS is defined as the time from first treatment with the study drug to the earliest of either disease progression or death from any cause. Patients who are alive and progression free will be censored at the time of their last follow-up. The Kaplan-Meier method was used to evaluate time to event endpoints. Median PFS was reported with a 95% confidence interval. Data will be presented as Kaplan Meier plots.
Time frame: Time from first treatment with the study drug to the earliest of either disease progression or death from any cause, assessed up to 24 months.
Objective Response Rate (ORR) in Belinostat, SGI-110
Best Objective Response per RECIST Version 1.1 criteria. CR, complete response defined by the disappearance of all target lesions; PR, partial response defined by at least a 30% decrease in the sum of the diameters of target lesions; SD, stable disease defined by neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for progressive disease; PD, progressive disease defined by at least a 20% increase in the sum of the diameters of target lesions or the appearance of one or more new lesions.
Time frame: Within 6 months after initiating study treatment.
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UCHealth University of Colorado Hospital
Aurora, Colorado, United States
Yale University
New Haven, Connecticut, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
Coral Gables, Florida, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
Deerfield Beach, Florida, United States
Mayo Clinic in Florida
Jacksonville, Florida, United States
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